Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-2695
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
1450 JOHNS LAKE RD, CLERMONT, FL 34711-6798
(352) 243-6270
(479) 277-4331
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH21709
FL
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031219300
—
FL
05
—
031219301DME
—
FL
01
—
2005435
PK
—
05
—
PH21709
—
FL
Enumeration date
07/17/2006
Last updated
09/19/2025
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